The importance of sleep

Some people say that there will be time for sleeping when we die. Unfortunately, by having this attitude, one may get to test it sooner rather than later. There is no shame in sleeping. Some wear it as a badge of honor that only 4 hours of sleeping is needed, but as you’ll see later this is not a good idea. Here’s a list of power people that sleep less than the 6-8 hours per night recommended.

“…it has been recommended to consider sleep as another vital sign, as sleep can give insight into the functioning and health of the body.”

There have been multiple suggested vital signs such as pain, walking speed and now sleep. I am not saying that sleep isn’t important, but to call it a vital sign may be over-rated.

“…between 50 and 70 million adults in the US experience chronic sleep disturbances, and 62% experience a sleep problem several nights a week.”

Sleep is vital, but maybe not a “vital sign”. If you are having a problem with sleep, this could be a sign of something more serious, if not it could lead to something more serious.

For instance, my daughter has Down Syndrome. This is a genetic mutation of the 23rd chromosome, which leads to multiple physical changes. One of the changes is a larger than average tongue and smaller air passages. This is in combination with low muscular tone. The incidence of sleep apnea in kids with Down Syndrome is 50-100%. One of the side effects of sleep apnea is right sided heart failure, pulmonary hypertension, and delayed growth. These are some serious effects of a lack of sleep. I can speak for my daughter, but she will undergo a sleep study around the age of 3-4. I have some patients that have sleep issues and this is what I hear about doing a sleep study:

“It will be too inconvenient”

“I don’t want to know the results”

“I don’t want to have anyone watch me sleep”

In the grand scheme of things, I will not let ego override my daughter’s long term health. I don’t understand this belief system, but will always try to educate the patients in order to ensure that my patient’s health is as good I know that it has the potential to be.

“Costs associated with insomnia, which is the most prevalent sleep disorder, are over $100 billion per year due to health care costs, accidents, and decreased work.”

Difficulty falling asleep or staying asleep is termed insomnia. Think of how much money we spend in health care related costs. Add musculoskeletal pain costs to isomnia costs and the total is 340 billion.

If you could save $100,000/year, it would take you 3,400,000 years to save 340 billion dollars. If you could save $10,000 every single day, then it would only take you 93,151 years to save 340 billion.

As you can see, if we can start to improve national health, then we have the potential to save more money than I could count to in a lifetime.

“…proposed that knowledge about sleep and skills to screen sleep disorders and to promote quality sleep are important components for physical therapists to promote health and wellness.”

I’ll be honest. We don’t learn much about sleep in school. At least we didn’t 10 years ago. It’s hard to say if this has changed much in the previous decade, as I don’t hear many new graduates talking about sleep. Everything that I learned about sleep and health has come from a few podcasts from people like:

It’s great that there is more research being published in the field of PT regarding sleep, but this is a population health issue and needs to be addressed by all health care professionals.

“Of the 43% who reported that they do not routinely assess their patient’s sleep habits or sleep quality, the most frequently reported reason was: ‘I do not know how to assess sleep habits or sleep quality.'”

I am not surprised by this number…actually I am. I am shocked that it is not higher. I am shocked that half of all therapists are actually assessing sleep habits or sleep quality. I think that most of us, in orthopedics ask whether or not sleep is disturbed, but I don’t know if this qualifies for asking about quality and sleep habits. Actually, I hope it doesn’t because this is a basic question that doesn’t assess much other than sleep or no sleep due to pain.

I ask my patients about urinating during the night, how many hours of sleep is achieved during the night, what the environment (room) is like regarding electronic devices and lights.

This is stuff that I had to learn on my own and wasn’t even mentioned in a Doctorate program.

We already talked about heart health and sleep quality in the personal story of my daughter.

There is some published research regarding a lack of sleep and an increase in Substance P.

Dr. Kirk Parsley speaks frequently of the effects of a lack of sleep on cognition.

“Without adequate sleep, people can experience increased pain perception, loss of function and reduced quality of life, depression, increased anxiety, attention deficits, information processing disruption, impaired memory and reduced ability to learn new motor skills, and are at an increased risk for accidents, injuries and falls.”

I don’t think that too many people will argue about the importance of sleep. We absolutely need it, but some can go days without sleep. Albeit, there will be some side effects.

“People with sleep disturbances report increased sensitivity to pain, but also those experiencing high pain intensity have reported significantly less total sleep time, delayed sleep onset, increased nighttime wakening, and decreased sleep efficiency.”

As a therapist, this part plays an important role in my care. I would estimate that about 90% of my patients are coming to me for some sort of pain complaint. Sometimes this pain can keep the patient awake. Knowing the role of Substance P regarding pain and sleep, I ask 100% of my patients about sleep. If sleep is disturbed, then I know that I have to attempt to understand the problems with sleep. If the problems go beyond sleep hygiene, then the patient is referred out to a doctor that specializes in sleep studies.

This is why it is so important for PT’s to ask about sleep! It may affect our outcomes!

We are all (I’m an optimist) trying to get patients better and we have to look at all of the variables that we can manipulate in order to achieve this goal.

“understanding the important relationship between sleep and pain could profoundly influence the treatment interventions targeted toward changing the patient’s experience of pain”

Just by improving sleep, we may be able to decrease a patient’s pain experience and improve function as a result.

“long duration of sleep (>8-9 h per night) was associated with an increased mortality due to cardiovascular disease and increased risk of developing coronary heart disease…short sleep duration (<5-6 h per night) was associated with an increased risk of developing or dying from coronary heart disease and weakly associated with developing other cardiovascular diseases.”

This is the paradox of sleep. Get too little and no bueno, but get too much and equally no bueno. Looks like 6-8 hours per night appears to be the right amount. Reading this paragraph makes me think of the three bears.

“Sleep apnea…increases the risk of developing cardiovascular disease…heart failure and stroke…breathing stops temporarily, which decreases the level of oxygen in the body alerting the brain to excite certain receptors.”

Fight or flight? When a person stops breathing, the body becomes excitable and stresses out. This stress can raise BP, increase heart rate and cause other neurological responses.

“About 75% of people with depression experience symptoms of insomnia…almost 20% of those with insomnia have clinically significant depression and anxiety.”

This is a quick question that we can ask when someone notes that they have anxiety or depression, which is typically asked on a history intake form.

“sleep may play an important role to the development of Alzheimer’s disease”

This has to do with neurofibrillar tangles in the brain. This is another topic of concern for me and my family.

We are doing a lot of studying in order to understand the ramifications of Down Syndrome and there is a high likelihood of developing Alzheimer’s disease.

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Published by Dr. Vince Gutierrez, PT, cert. MDT

After having dedicated 8 years to growing my knowledge regarding the profession of physical therapy, it seems only fitting that I join the social media world in order to spread a little of the knowledge that I have gained over the years. This by no means is meant to act in place of a one-one medical consultation, but only to supplement your baseline knowledge in which to choose a practitioner for your problem. Having completed a Master of Physical Therapy degree, the MDT (Mechanical Diagnosis and Therapy) certification and currently finishing a post-graduate doctorate degree, I have spent the previous 12 years in some sort of post-baccalalaureate study. Hopefully the reader finds the information insightful and uses the information in order to make more informed healthcare decisions.
MISSION STATEMENT:
My personal mission statement is as follows: As a professional, I will provide a thorough assessment of your clinical presentation and symptoms in order to determine both the provocative and relieving positions and movements. The assessment process and ensuing treatment will be based on current and relevant evidence. Furthermore, I will educate the patients regarding their symptoms and their likelihood of improving with either skilled therapy, an independent exercise program, spontaneous recovery or if the patient should be referred to a separate specialist to possibly provide a more rapid resolution of symptoms. Respecting the patient’s limited resources is important and I will provide an accurate overview of the prognosis within 7 visits, again based on current research. My goal is to empower the patient in order to take charge of both the symptomatic resolution and return to full function with as little dependence on the therapist as possible. Personally, I strive to be an example for family and friends. My goal is to demonstrate that success is not a byproduct of situations, but a series of choices and actions. I will mentor those, in any way possible, that are having difficulty with the choices and actions for success. I will continue to honor my family’s “blue-collar” roots by working to excel at my chosen career and life situations. I choose to be a leader of example, and not words, all the while reducing negativity in my life.
I began working towards the professional aspect of the mission statement while still in physical therapy school. By choosing an internship that emphasized patient care and empowering the patient, instead of the internship that was either closest to home or where I knew that I would have the easiest road to graduation, I took the first step towards learning how to utilize the evidence to teach patients how to reduce their symptoms. I continued this process by completing Mechanical Diagnosis and Therapy courses A-D and passing the credentialing exam. I will continue to pursue my clinical education through CEU’s on MDT and my goal is to obtain the status of Diplomat of MDT. Returning back to school for the t-DPT was a major decision for me, as resources (i.e. time and money) are limited. My choice was between saving money for the Dip MDT course (about 15,000 dollars) and continuing on with the Fellowship of American Academy of Orthopedic Manual Physical Therapists (FAAOMPT) (about 5,000 dollars), as these courses are paired through the MDT curriculum or returning to school to work towards a Doctorate of Physical Therapy degree. I initially planned on saving for the Dip MDT and FAAOMPT, but life changes forced me to re-evaluate my situation. The decision then changed to return for the tDPT, as my employer paid for a portion of the DPT program. My goal for applying to and finishing the Dip MDT and FAAOMPT is 10 years. This is how long I anticipate that it will take to finish paying student loans and save for both programs, based on the current rate of payment.
I don’t know if I will ever accomplish what I set forth in the mission statement, but I do know that it will be a forever struggle to maintain this standard that I set for myself.
View all posts by Dr. Vince Gutierrez, PT, cert. MDT